National Data Report: Highly Sensitized Patient Program

Highly Sensitized Patient Program 2013-2018

The Highly Sensitized Patient program was initiated in the Fall of 2013 and has become a cornerstone of Canadian Blood Services’ contribution to the organ donation and transplantation system in Canada. It provides access to deceased donors on a national scale for kidney transplant candidates who have significantly reduced access to compatible donors due to their immunological profile.

The data in the following report has been extracted from the CTR and covers the period of 2013–2018, from the initiation of the HSP program (started in November of 2013) until December of 2018.

Key success factor: Interprovincial organ sharing

Interprovincial cooperation continues to be crucial to the success of the HSP program. At the end of 2018, the HSP program facilitated 499 transplants, 297 of which being interprovincial transplants. The proportion of interprovincial transplants facilitated through the HSP program is increasing year over year, with 68 per cent of transplants facilitated in 2018 involving a donor and recipient from programs in different provinces.

Hardest to match transplant candidates

The vast majority of active transplant candidates registered in the HSP program at any given time are in the hardest to match group. These are candidates whose calculated Panel Reactive Antibody (cPRA) rating suggests that they would be a match with fewer than one donor in 100 (cPRA 100%). In most cases, transplant candidates with a cPRA 100% can be expected to match 0.1 per cent of donors or fewer. To date, only 15 per cent of cPRA 100% transplant candidates who have participated in this program received a transplant through the program, primarily due to the difficulties in finding a compatible donor. To address these difficulties, the HSP program policy regarding organ allocation was amended in 2016 to prioritize HSP transplant candidates in the highest cPRA categories, which resulted in a significant increase in transplants for these hard to match candidates. Of the 240 transplants facilitated by the HSP program prior to the implementation of the revised allocation policy, only 51 were to cPRA 100% patients, while 74 transplants were facilitated through the program to cPRA 100% patients in the first 240 transplants that followed the policy’s implementation. This represents a 47 per cent increase in the number of cPRA 100% patients receiving transplants. cPRA 99% patients who were also given priority access to compatible donors benefited from this policy shift as well.

Fewer future transplants possible

Despite these advancements, current results suggest that fewer transplants may be possible through the HSP program in the future, especially for the hardest to match transplant candidates (cPRA 99% and 100% patients). This is due to a confluence of factors, including the increasing proportion of cPRA 100% transplant candidates (the hardest to match) in the candidate pool.

New measures and operational metrics

In addition to ongoing monitoring and reporting, proactive measures to enhance transplant opportunities are currently being considered, with select measures (such as incorporating new antibody crossing options and transitioning to more precise compatibility measurements) potentially being implemented in the future. As a complement to ongoing improvements, current operational metrics are extremely positive, including low rates of immunological problems that would prevent proposed transplants from proceeding and infrequent cases in which transplants are not able to be completed to the intended recipient. A major achievement for the HSP program is the low number of unexpected positive crossmatches. Transplant outcome results are also high, with both graft survival and patient survival being within expected ranges for deceased donor transplants.

  • By the end of 2018, the HSP program facilitated 499 transplants, 297 of which were interprovincial transplants.

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